scholarly journals SAPHO syndrome associated with a digestive disorder in a ten-year-old girl: Diagnostic difficulties

2022 ◽  
Vol 13 (1) ◽  
pp. 57-61
Author(s):  
Bérénice Dégboé ◽  
Gloria Nouhoumon ◽  
Christabelle Nguessie ◽  
Fabrice Akpadjan ◽  
Nadège Agbéssi ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Clinical Case ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Sapho Syndrome ◽  
Digestive Disorder ◽  
Multidisciplinary Consultation ◽  
Diagnostic Difficulties ◽  
Inflammatory Syndrome

SAPHO syndrome (acronym for synovitis, acne, pustulosis, hyperostosis, osteitis) is a rare dermato-rheumatic entity usually observed in young adults. The clinical manifestations are proteinaceous and without specificity at the origin of inflammatory diseases of the intestine. Our clinical case is that of a ten-year-old girl who presented with chronic and recurrent osteomyelitis of the pelvic limbs on a febrile background, followed by persistent and recurrent pustular lesions. During the same period, because of an acute abdominal pain syndrome accompanied by fever, a biological inflammatory syndrome, and predominantly neutrophilic hyperleukocytosis, laparotomy was performed and no lesions were found. She subsequently presented with intermittent and recurrent spasmodic abdominal pain. In view of these various symptoms, a multidisciplinary consultation concluded that the patient had SAPHO syndrome associated with a digestive disorder, possibly Crohn’s disease. Our clinical case illustrates the diagnostic difficulties of SAPHO syndrome.

scholarly journals Cholestatic hepatitis as a clinical mask of choledocholithiasis

2016 ◽  
Vol 97 (3) ◽  
pp. 439-442
Author(s):  
D V Pikulev ◽  
O N Vorob’eva
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hiatal Hernia ◽  
Bile Ducts ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Cholestatic Hepatitis ◽  
The Common

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.

scholarly journals Chronic musculoskeletal pain in neurological practice

2021 ◽  
pp. 22-28
Author(s):  
D. Kh. Khaibullina ◽  
Yu. N. Maksimov ◽  
F. I. Devlikamova
Keyword(s):  
Back Pain ◽  
Musculoskeletal Pain ◽  
Muscle Relaxant ◽  
Clinical Case ◽  
Pain Treatment ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Pain Syndrome ◽  
Chronic Musculoskeletal Pain ◽  
Herniated Disc

Treatment of musculoskeletal back pain is an essential problem for doctors of many specialties, including neurologists. In some cases, the chronic course of the pain syndrome is accompanied with complaints and clinical manifestations characteristic of neuropathic pain in the absence of significant damage to the neural structures, which is explained by the mechanism of central sensitization. In this case, there may be diagnostic errors in determining the nature of the pain, which entails inadequate therapy that does not lead to the desired result.The presented clinical case is devoted to the treatment of exacerbation of chronic musculoskeletal pain. Treatment of the patient for a herniated disc complicated by radiculopathy, carried out earlier, did not lead to the desired result due to the inconsistency of the diagnosis, inadequacy and lack of systematic therapy. Based on the analysis of the physical and paraclinical studies, the diagnosis was changed to « Lower back pain. Myofascial pain syndrome. Toxic polyneuropathy. Herniated disc LV-SI. Residual radiculopathy S1». Therapeutic measures were adjusted in accordance with the diagnosis. In order to relieve the pain syndrome at the first stage, a combined drug Neurodiclovit, a muscle relaxant, a drug of the SYSADOA group, soft tissue techniques of manual therapy, phonophoresis with glucocorticosteroids, and cognitive behavioral therapy were used. The assessment of the patient’s condition carried out after 7 days showed the effectiveness of the treatment, which allowed to cancel the use of a nonsteroidal anti-inflammatory drug, a muscle relaxant and a glucocorticosteroid. At the post-treatment stage, the patient was prescribed a combination of B vitamins (Neuromultivitis) and therapeutic gymnastics, as well as continued therapy with a slowacting symptomatic agent and non-drug treatment methods. Relief of the pain syndrome in the absence of adverse events confirmed the adequacy and effectiveness of the therapy.The presented clinical case demonstrates the importance of placing emphasis at the stage of diagnosis, taking into account the data of clinical and paraclinical research methods, and also illustrates the possibility of successful conservative therapy for exacerbation of chronic musculoskeletal pain in the practice of a neurologist.

Volume formation of the orbit in hemoblastosis

2021 ◽  
Vol 22 (1) ◽  
pp. 114-117
Author(s):  
M. N. Ponomareva ◽  
◽  
I. N. Pakhirko ◽  
I. A. Arefieva ◽  
E. S. Klimov ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Clinical Case ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Hodgkin's Lymphoma ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Hematology is the most important branch of practical medicine, thanks to significant advances in the diagnosis and treatment of hemoblastosis. The earlier the timely complex treatment is started, the better the vital prognosis and fewer complications. Aim.To present a clinical case of volumetric orbit formation in a 67-year-old man with hemoblastosis. Materials and methods. A retrospective analysis of the dynamics of the development of clinical manifestations and diagnostics of the volume formation of the orbit in a patient born in 1954 was carried out. Results. The patient suffers from diffuse non-Hodgkin’s lymphoma, unspecified, with lesions of the axillary lymph nodes on both sides, the soft tissues of the chest on the right, and the peritoneum. Chronic pain syndrome. The diagnosis was made in the oncological dispensary, where he was in 28.12.2020. Complaints from the organ of vision appeared on 09.01.2021, but the patient was not examined by an ophthalmologist. The immunohistochemical study of 15.01.2021 confirmed the morphological picture of the lymphoproliferative disease, but the patient did not receive specialized antitumor therapy, and therefore the ophthalmic symptoms continued to increase, vision loss and pain syndrome increased. Regarding the above complaints, the patient went to the emergency room of ophthalmological care. Computed tomography of the brain and orbits was performed in addition to standard ophthalmological examinations. The formation of the left orbit with exophthalmos was diagnosed. Conclusion. This clinical case shows that in male patients, aged 67 years, the ophthalmological manifestations of non-Hodgkin’s lymphoma may be metastasis to the orbit with a gradual increase in the clinical picture (displacement of the eyeball, movement restrictions, exophthalmos), for 2 weeks, while maintaining visual functions (visual acuity 0.7-0.8) and the occurrence of conjunctivitis.

scholarly journals Clinical implications of chronic mesenteric ischemia in elderly and senile patients

2020 ◽  
Vol 92 (2) ◽  
pp. 74-80
Author(s):  
A. I. Dolgushina ◽  
A. S. Kuznecova ◽  
A. A. Seljanina ◽  
V. V. Genkel ◽  
A. G. Vasilenko
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia ◽  
Clinical Criteria

Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

scholarly journals Spontaneous splenic rupture

2020 ◽  
Vol 24 (2) ◽  
pp. 250-252
Author(s):  
I. O. Kozak ◽  
S. A. Sukhodolia ◽  
L. I. Kozak ◽  
V. V. Ladyshkin
Keyword(s):  
Abdominal Pain ◽  
Literature Review ◽  
Spontaneous Rupture ◽  
Clinical Case ◽  
Splenic Rupture ◽  
Clinical Manifestations ◽  
Diagnostic Errors ◽  
Pathological Changes ◽  
Spontaneous Splenic Rupture ◽  
Rupture Of The Spleen

Annotation. We represent a clinical case of spontaneous rupture of the spleen in a patient 35 years old without of signs of injury and pathological changes of the organ. Based on own clinical experience and literature review, the extreme rarity of such pathology, the atypicality of its clinical manifestations, the causes of diagnostic errors and grave consequences are considered. It is noted that in the operation for acute appendicitis in the absence of destructive changes in the appendix, it is mandatory to search for the cause of abdominal pain, one of which may be a spontaneous rupture of the spleen.

scholarly journals Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up

2017 ◽  
Vol 89 (2) ◽  
pp. 70-75
Author(s):  
Yu V Makarovа ◽  
N V Litvinova ◽  
M F Osipenko ◽  
N B Voloshina
Keyword(s):  
Quality Of Life ◽  
Abdominal Pain ◽  
Time Course ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Assess Quality ◽  
Group 1

Aim. To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). Subjects and methods. This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. Results. Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p

scholarly journals Gastrointestinal tract diseases at different stages of COVID-19 in children

2021 ◽  
Vol 1 (6) ◽  
pp. 18-28
Author(s):  
G. S. Karpovich ◽  
I. V. Kuimova ◽  
A. E. SHestakov ◽  
I. Ya. Izvekova ◽  
L. M. Panasenko ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Laboratory Tests ◽  
Pediatric Patients ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Immune Development ◽  
Icd 10 ◽  
One Year ◽  
Inflammatory Syndrome

Purpose of the study. To investigate the features of lesions of the gastrointestinal tract in diff erent variants of the course of COVID-19 in children.Materials and methods. A single-center prospective study was carried out to study the clinical and laboratory manifestations of gastrointestinal tract (GIT) lesions in different variants of the course of COVID-19 in children. The study was carried out in the following groups: group No. 1 — pediatric patients with a verified diagnosis (according to ICD 10) “U07.1. COVID-19 virus identified, confirmed by laboratory tests, regardless of the severity of clinical signs or symptoms ”, n = 524; group No. 2 — pediatric patients with a verified diagnosis (according to ICD 10) “U10.9 Multisystem inflammatory syndrome associated with COVID-19, unspecified”, n = 46. The article provides a brief description of the observations of the development of autoimmune pathologies (ulcerative colitis, autoimmune hepatitis) in pediatric patients, for whom a postponed COVID-19 infection could be a probable trigger.Results. The leading symptoms of the gastrointestinal tract in patients of group No. 1 were symptoms of acute gastroenteritis, registered in 37.6% of cases. Diarrhea was detected in 21.2% of cases, vomiting — in 16.5%; abdominal pain syndrome — 9.2%. These manifestations were statistically more significant in patients under one year of age, as well as in children of the first three years of life (p≤0.05). Gastrointestinal syndrome in patients of group No. 2 was registered in 67.4% of cases, with vomiting — 60.9% of cases, diarrheal syndrome — 23.9% of cases, abdominal pain syndrome — 82.6%. Other manifestations of the gastrointestinal tract in patients of this group were: reactive hepatitis — 69.6% of cases (average ALT — 98 (47; 347); AST — 107 (34; 347)), reactive pancreatitis — 60.8% of cases (average values of amylase — 127 (28; 269); lipase — 196 (47; 107)). These lesions were of a reactive inflammatory nature, with a probable immune development mechanism.

scholarly journals Defining Kawasaki Disease and Pediatric Multi-Inflammatory Syndrome During SARS-CoV-2 Epidemic in Italy: Results From A National, Multicenter Survey.

2020 ◽  
Author(s):  
Marco Cattalini ◽  
Sara Della Paolera ◽  
Fiammetta Zunica ◽  
Claudia Bracaglia ◽  
Manuela Giangreco ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Laboratory ◽  
Troponin T ◽  
Inflammatory Diseases ◽  
Age At Onset ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Chi Square ◽  
Multicenter Survey ◽  
Inflammatory Syndrome

Abstract Background: There is mounting evidence on the existence of a Pediatric Multi-inflammatory Syndrome related to SARS-CoV-2 (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities.Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group – KDG) or KD-like (Kawacovid Group - KCG) disease. Demographic, clinical, laboratory data, treatment information, and patients’ outcome were collected in an online anonymized database (RedCAP). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groupsResults: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis and 37,8% with hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated Ferritin and Troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p=0.04 and 71,9% vs 43,4%; p=0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p<0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p<0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data.Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.

scholarly journals Internal hernia as one of the causes of abdominal pain

2019 ◽  
Vol 10 (2) ◽  
pp. 27-35
Author(s):  
V. M. Kitaev ◽  
E. G. Koshelev ◽  
O. V. Sokolova ◽  
G. Yu. Belyaev ◽  
A. A. Egorov ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Abdominal Cavity ◽  
Pain Syndrome ◽  
Internal Hernias ◽  
Diagnostic Difficulties ◽  
Modern Classification ◽  
Acute Small Bowel Obstruction ◽  
Ct Data

Abdominal pain is often observed in clinical practice, causing diagnostic difficulties for doctors of different specialties. Internal hernias are a surgical pathology and may be the cause for the development of acute small bowel obstruction and the occurrence of pain. A modern classification of internal hernias is presented and their topographic-anatomical description is given. The analysis of the results of computed tomography (CT) scan of the abdominal cavity in 20 patients with an unidentified cause of abdominal pain was performed. According to the CT data, three patients had internal hernias that caused the development of pain syndrome. A pathological displacement of intestinal loops with partial disruption of intestinal permeability and curvature of the mesentery without critical disturbance of blood supply was demonstrated in 4 patients with abdominal pain. The findings suggest that CT may be the method of choice when examining patients with an unknown cause of abdominal pain syndrome.

scholarly journals Application of the complex algorithm for rehabilitation of patients needing a full reconstruction of dentition (clinical case)

2020 ◽  
Vol 24 (3) ◽  
pp. 158-163
Author(s):  
Fatima K. Dzalaeva ◽  
S. O. Chikunov ◽  
A. S. Utyuzh ◽  
Z. K. Dzhagaeva ◽  
A. V. Yumashev
Keyword(s):  
Clinical Case ◽  
Myofascial Pain ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Diagnostic Methods ◽  
Instrumental Analysis ◽  
Results Of Treatment ◽  
Full Reconstruction ◽  
Complex Algorithm

Introduction. Aim of the study is testing the algorithm of complex clinical, functional and instrumental analysis in the treatment of patients with the need for total restoration of the dentition with manifestations of myofascial pain syndrome. Material and methods. A system for the rehabilitation of patients with adentia is proposed, in which, when planning occlusion correction, objective examination data for patients obtained using a set of diagnostic methods should be taken into account. Particular attention is paid to assessing the function of the temporomandibular joint and the presence of pathological signs of disorders of maxillofacial muscles. Results. A clinical case is described a patient who has been diagnosed with a set of indicators of clinical, functional and instrumental analysis obtained using methods of condylography and cephalometry. The results of treatment and rehabilitation measures allowed achieving the optimal distribution of loads on the dentition, while reducing the risk of ceramic chipping and improving oral hygiene. The approach used allowed timely correction of functional and aesthetic disorders. Conclusions. The algorithm for working with patients who need total restoration of the dentition should include a thorough history taking, clinical functional analysis using condylography methods, model analysis to register and evaluate the static and dynamic ratios of the dentition. As well as performing cephalometric analysis and other manipulations, in accordance with standard criteria for clinical examination. The developed algorithm is anatomically and pathogenetically justified, since it takes into account the entirety of changes and interconnections of the structures of the dentofacial system and other body systems that underlie the clinical manifestations in this category of patients.

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